The final verdict may not be in yet, but some of the early returns on "ObamaCare" are not good. Indeed, many doctors are becoming wary of the law at a time when only one in three Americans support it.

In late December, a survey of 501 physicians was released (http://www.deloitte.com/assets/Dcom-UnitedStates/Local%20Assets/Documents/us_lshc_PhysicianPerspectives_121211.pdf) by the Deloitte Center for Health Solutions research group, whose parent company serves clients in the health care industry. Nearly half (48%) expected health reform to hurt their incomes this year, while 73% said it would not reduce costs.

Though this isn't a scientific survey, and other such surveys have and will show physicians' support for the Affordable Care Act (http://content.usatoday.com/topics/topic/Affordable+Care+Act), the early glimpse of the law's potential impact will likely lead to economic pain for doctors and a diminished system for their patients. Indeed, the Deloitte survey found that 69% of the physicians are "pessimistic about the future of medicine" because of the law.

I'm not here to judge doctors who back ObamaCare. But as a practicing physician, I simply need to look at the economics of medicine, apply my own experience and see the law as it unfolds to know that physicians across this country should be demanding if not a new system, at least a better one.

The early days

In June 2009, when President Obama attended a "white coat" ceremony (http://www.usatoday.com/news/washington/2009-06-15-obama-speech-text_N.htm) at the American Medical Association (http://content.usatoday.com/topics/topic/Organizations/Non-profits,+Activist+Groups/American+Medical+Association) headquarters in Chicago, and this organization of physicians (roughly 17% are members) went on to deliver its endorsement (http://www.usatoday.com/news/health/2009-07-17-ama-healthcare_N.htm) of the president's legislation, physicians had a nagging question: Did we agree with the AMA's position, or was the organization taking us for a ride? The answer is becoming clearer as the law is being implemented.

An online survey (http://www.jacksoncoker.com/news/News.aspx?sc_cid=AMA) in September by the Jackson & Coker physician recruitment firm — based on 1,611 doctors who chose to respond — reflected that the majority of doctors don't believe that the AMA represents their views. The primary reason: the AMA's support of the legislation. Just 13% of those surveyed backed the Affordable Care Act.

Doctors traditionally have been unhappy with insurance mandates because third-party payers, whether public or private, represent a seemingly unnecessary interface between us and our patients. Many doctors today prefer to accept cash, even at a great discount, rather than having to deal with the burden imposed by insurers.

Yet the glaring inadequacy of the health care reform law is that putting the bureaucratic burdens on steroids does little to change the trajectory of health care spending. The law also floods the system with patients while tightening the financial screws on those in the health care industry.

We're two years into this experiment, and the realities of the law — more regulations, more patients with low-paying insurance, higher costs but lower payments to doctors — are sinking in.

When surveyed by Deloitte (http://www.deloitte.com/assets/Dcom-UnitedStates/Local%20Assets/Documents/us_lshc_PhysicianPerspectives_121211.pdf), 83% of doctors said one likely change to the medical system as a result of the law would be increased wait times — an inevitable outcome of insuring millions more patients without a matching increase in the number of doctors. Not too surprising. Most doctors surveyed also noted that the changes will "pose considerable implementation challenges." I suspect it would be hard to find someone in the health care industry — or any employer, for that matter — who would disagree with that expectation.

And it doesn't get better

It's one thing to mandate insurance for all, but quite another to do so without incentivizing physicians or those considering the profession. In fact, the law does the opposite: For many doctors, there becomes a financial disincentive to practice medicine.

The Association of American Medical Colleges estimates that (https://www.aamc.org/newsroom/presskits/physician_workforce/) the USA will be 160,000 physicians short by 2025 (when all patients would be insured under ObamaCare), and this is without even considering those doctors who will limit their practice to insured patients because of decreasing reimbursements or who retire early when faced with increasing costs with little return.

Doctors are catching on fast to the essential deficiencies of ObamaCare, but so are America's patients. The concern of doctors is reflected among the American people: Support for the law (http://ap-gfkpoll.com/featured/president-obama-and-the-economy) has sunk to 29% in the latest Associated Press poll.

Think of ObamaCare as a heavy horse-drawn cart loaded with all of America's patients and best technologies. As the cart gets heavier and heavier, does it make sense that we don't add more horses but instead feed the ones we have less and less while expecting them to pull the additional weight?

I think more and more doctors are going to pull up lame if the law's many shortfalls aren't addressed — and stat.

Marc Siegel, a physician, is an associate professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is the author of The Inner Pulse and a member of USA TODAY's Board of Contributors.

DOCTORS ARE GREEDY A-HOLES THAT ONLY TRY TO TAKE PEOPLES' MONEY. THEY PERSCRIBE DRUGS SO THEY CAN GET KICKBACKS FROM BIG PHARMA. THEY MAKE ME WAIT IN THE WAITING ROOM FOR WAY TOO LONG! :cuss:

Cave Johnson

01-19-2012, 02:03 PM

The AMA argued against Medicare, and it turned out to be a boon for doctors (by monetizing patients that were previously receiving charity care). Why should this be any different?

I have even less charitable things to say about their concern for maintaining current income levels.

Doctors traditionally have been unhappy with insurance mandates because third-party payers, whether public or private, represent a seemingly unnecessary interface between us and our patients. Many doctors today prefer to accept cash, even at a great discount, rather than having to deal with the burden imposed by insurers.

Doctors hate health insurers? So do I. They're terribly inefficient.

Let's get rid of them. You gonna listen to the doctors on that one, Pete?

La literatura

01-19-2012, 02:11 PM

WTF would doctor's know more about healthcare than politicians?

Is this act really about healthcare in the sense that doctors are experts on (ex: 24% of patients respond better to X drug after surgery). I don't think so. Instead, ObamaCare seems to be about federal regulation over a significant slice of the national economy.

orange

01-19-2012, 02:20 PM

http://blog.timesunion.com/mdtobe/files/2010/10/smoking.jpg

mlyonsd

01-19-2012, 02:34 PM

http://blog.timesunion.com/mdtobe/files/2010/10/smoking.jpgSounds like in 2025 there's a chance most doctor's will smoke. Well the ones that are practicing out of tattoo parlors I mean.